Standing Committee E

[Mr. Peter Atkinson in the Chair]

Health and Social Care (Community Health and Standards) Bill

Clause 42 - Standards set by Assembly

Chris Grayling: I beg to move amendment No. 476, in
clause 42, page 14, line 31, leave out 'may' and insert 'must'.

Peter Atkinson: With this it will be convenient to discuss the following amendments: No. 477, in
clause 42, page 14, line 33, leave out from 'may' to end of line 34 and insert 
 'amend the standards whenever it considers it appropriate. The National Assembly must publish amended statements'.
 No. 478, in 
clause 42, page 14, line 35, leave out from 'must' to end of line and insert 'publish proposals for consultation'.

Chris Grayling: I have taken it upon my shoulders to move the amendment, particularly as I want to discuss amendment No. 470.

Peter Atkinson: Order. Amendment No. 470 has not been selected.

Stephen Pound: I invite the Under-Secretary to consider the benefits and advantages of the amendment. A fairly minor amendment in many ways, it seeks to progress matters slightly and to underline the significance of clause 42. I am happy to address any issues later.

Chris Grayling: Having moved the hon. Gentleman's amendments, I will pick up his point from a different perspective. We on these Benches are anxious about separate standards for England and Wales. Amendment No. 476 inserts ''must'' as opposed to ''may'', thus compounding the problem. Rather than giving the Assembly discretion over whether Wales has standards separate from those in England, the amendment will place a requirement on the Assembly. That is wrong for two reasons. First, if one believes in devolution and local responsibility, one must allow the local decision-making body—in this case the Assembly—the freedom to decide whether it wants to opt into standards established for the entire United Kingdom, or for England and Wales, or to propose its own set of standards to meet the needs of its own country.
 The second reason for our profound anxiety is that having two different sets of standards moves us away from a national health service, which is a development that we should not welcome. That will create issues in cross-border areas and unwanted discrepancies between England and Wales. I am in favour of local accountability, but the natural correlation to setting up two sets of standards—we will discuss that later in 
 the debate—is two different inspection regimes, and the result of that would be a lesser amount of good care for patients, duplication of resources and bureaucracy and a waste of public money. 
 If we bring an iron curtain down along the border between England and Wales, not only will that have an adverse effect on patients in cross-border areas, but we will lose the opportunities for sharing best practice across the border, for clinical treatment flows from one side of the border to the other, and for Wales to learn from experience in England. The end result will be a genuinely local health service. If the Government's policy is to have a Welsh health service and an English health service and to move away from the principle of a national health service, let them say so loud and clear. 
 Whitehall Ministers may want to get the Welsh health service off their hands. That is understandable, because the Welsh health service is not functioning well and is not responding to the aspirations of central Government. 
 Some of the statistics are absurd. In Wales there are 71,000 more people waiting more than six months for out-patient treatment than there are in England. There are 46 million more people in England than in Wales, so it is quite an achievement to perform as badly as that. 
 People in border areas are being disadvantaged by the discrepancies in the standards and frameworks on both sides of the border. A Welsh patient was told by his nearest hospital, which is in Shropshire, that he had to wait six months longer for his hip operation than English patients in the same situation, because he was Welsh. A gentleman from north Wales who had been waiting more than 16 months for vital heart surgery in a Liverpool hospital was informed by the hospital of a Government initiative under which all patients waiting more than five months would have the choice of undergoing surgery elsewhere. He was told that as he lived in Wales he would not be involved in the scheme because Welsh authorities had declined to take part. 
 Is it fair or appropriate to have an increasingly divergent health care system, with different standards, principles and priorities in border areas, where people may be looking to a local tertiary centre or local hospital for treatment? If we continue to go down the road of having separate systems in both countries, some people in border areas will not have the same access to health care as those who live a mile up the road. It is happening today and it will continue to happen as sure as night follows day. 
 Proper strategic decisions on a particular population area or a rural community are not being made. Communities that do not divide because there is a border between England and Wales are being treated differently by the health service. Decisions are being made on the basis of the villages that people live in. 
 It would be madness if the principle of standards meant that the two Administrations—the Secretary of State in Whitehall and the National Assembly for Wales—were telling clinicians to do one thing and not another. That would inevitably distort the services 
 available and the treatment that could be received by patients who live in border areas. 
 Last week, I briefly mentioned that it is perfectly conceivable—I have just illustrated that it happens—that a doctor in a clinic will have to treat his 10 o'clock and his quarter-past 10 appointments differently, even though both patients may have the same condition, because of the differences in the standards framework and the requirements placed on that doctor by the Welsh Assembly. It makes no sense. Ministers must be extremely careful about this matter.

Stephen Pound: I am reluctant to interrupt the hon. Gentleman in mid-flow because he seems to be constructing an exegesis that is comparable to the Schleswig-Holstein question. I appreciate that he has wider points to make; however, the purpose of the amendment is to compel the Welsh Assembly to take those factors into consideration and to drive up standards. How can he possibly have a problem with that? It would deal with the very issue of disparity in service provision about which he so eloquently speaks.

Chris Grayling: What the hon. Gentleman is saying in his amendment, and I do not doubt his honourable intentions, is that inserting the word ''must'' removes discretion from the Welsh Assembly to apply common sense.
 Let us suppose that in its wisdom—it would be in its wisdom—the Welsh Assembly decides that it is not in the interests of the Welsh people to have two different sets of standards. Let us suppose that it decides not to pay the money that will be required to the team that will produce a set of standards or the money that will be required to communicate those standards to medical practitioners across Wales, in border areas and in hospitals from Liverpool to Bristol. Let us suppose that it will decide not to pay the money required to set up an inspectorate to inspect those standards. 
 In its wisdom, the Assembly might judge it better to spend that money on patient care. The effect of the hon. Gentleman's amendment would be to say that it could not take that decision, which must be wrong.

Stephen Pound: Under the circumstances, why does the hon. Gentleman not simply suggest the deletion of subsection (1)?

Chris Grayling: I would be delighted to see clause 42 disappear. I would argue against clause 42 in its entirety, because it is not in the interests of the people in Wales, or those in England who live close to Wales, to have separate standards. That would be a hindrance to them and a waste of public money. In the same way, I shall argue this morning that it is not in the interests of those people to have two separate, parallel inspection processes.
 My concern about the amendment is that the word ''must'' creates an obligation. Clause 42(1) would then state: 
''The Assembly must prepare and publish statements of standards in relation to the provision of health care by and for Welsh NHS bodies.''
 That would remove from the Assembly the discretion to stick with the national standards that the Government have set out from Whitehall. It might choose to do otherwise. I think that it would be wrong to do so, but under this clause it would not have the ability to do so, and that would be a mistake. 
 It would be a particular mistake for cross-border areas. At least six trusts truly serve cross-border communities, including the North East Wales NHS trust and the Gwent Healthcare NHS trust. There are also the strategic health authorities on the English side of the border: Cheshire and Merseyside; Shropshire and Staffordshire; Coventry, Warwickshire, Herefordshire and Worcestershire; and Avon, Gloucestershire and Wiltshire. Each of those oversees services for significant numbers of patients from Wales. To ask each of those organisations to handle two different sets of standards would add yet more of a bureaucratic burden both to the managers running those trusts and, more particularly, to the clinicians who must deal with them. I see no benefit in doing that. 
 The only condition that I am aware of that came out of the debate on the Health (Wales) Bill that could be argued to be peculiar to Wales relates to those who worked in the limestone and slate industries. In a telling intervention last week, my hon. Friend the Member for Westbury (Dr. Murrison) asked the Minister how Welsh diabetes differs from English diabetes. The Minister must realise that after his Government have put the effort into creating a national service framework for diabetes, it would be nonsense if the Welsh tore that up and came up with something different just for them. 
 We must remember that although Wales has a proud tradition, it is also a geographical area with a population that is not much larger than Surrey and Sussex. Is it really sensible and a prudent use of public funds to have a set of standards devised for that number of people that differs from the standards that apply to their compatriots? That would cause confusion, complication and difficulties to practitioners who straddle both countries. 
 Therefore, the requirement under the amendment to follow that road would be short-sighted and would compound a problem that exists more broadly in clause 42, which in my view has no place in the proper provision of good health care for the future of England and Wales.

Jon Owen Jones: I oppose the amendment. Although it may make some sense to insert ''must'' instead of ''may'' in clause 42, clauses 41 and 42 are both worded in exactly the same way. Clause 41(1) states:
''The Secretary of State may prepare and publish statements''.
 Clause 42(1) says: 
''The Assembly may prepare and publish statements''.
 There is an argument that the word ''may'' should have been replaced by the word ''must''. However, if that is to happen, it should be replaced in both clauses rather than in the clause relating to the Assembly and not in the clause relating to the Secretary of State. I 
 have some sympathy for the application of common standards wherever possible. However, that will not be achieved by removing clause 42 in its entirety, because we would then need to reword clause 41. If we are to have common standards, it is surely not right for those standards to be imposed on Wales by the Secretary of State in Westminster without consultation.

Chris Grayling: I absolutely agree with the hon. Gentleman. I hope that if we stand against clause 42, it will secure the Under-Secretary's agreement to go away and rewrite both those clauses before Report. In that way we could have what the hon. Member for Cardiff, Central (Mr. Jones) and I both wish to achieve, which is a proper set of national standards with a bit of flexibility to deal with specific local issues such as those that we have discussed in relation to the slate industry.

Jon Owen Jones: I am glad that the hon. Gentleman has reminded me about the use of the word ''national'', because it has been applied so far to mean England and Wales. One can argue that England and Wales are two separate nations; what cannot be argued is that the combination of England and Wales is a nation. The British state is possibly a nation, in which case we need to be arguing about common standards to be applied in Northern Ireland, Scotland, Wales and England rather than to this greater England that just happens to comprise Wales as well. That is the way that the word ''nation'' has been used in the debate so far.
 It concerns me that we may have a wide range of standards, which would be deleterious to effective and efficient health care. I can think of circumstances in which some standards might diverge, but surely we should ensure that, as far as possible, common standards apply. The Bill does not do that in the best way. I do not support the amendments being proposed for the reasons that I have stated, and I do not support the deletion of clause 42, because it would make little sense, given the way in which the rest of the Bill is worded.

Gary Streeter: I am listening carefully to the hon. Gentleman's point about common standards. We heard earlier that health care outcomes in Wales seem to have fallen short of those achieved in England. I am simply requesting information: does he have an explanation for that?

Jon Owen Jones: I do not wish to be tempted too far down the road of explaining different health outcomes. What was referred to was the different waiting times, which are not quite the same thing as health outcomes. In comparing different parts of the country, it is not valid to compare health outcomes across all of England with those across all of Wales. It is more appropriate to compare health outcomes across Wales with those in the north-east of England, because the morbidity and mortality rates are more similar for those two areas. If one does that, the results also raise several questions. However, I do not think that it would be appropriate to debate them in the context of these amendments.

Don Touhig: I take this opportunity, Mr. Atkinson, to welcome you to the Chair on my first speaking appearance in the Committee. I look forward to your guidance taking us through these important Welsh clauses this morning.
 I also thank colleagues on both sides for their forbearance and understanding of my limited attendance in Committee. Earlier this year, I was on three Standing Committees on three separate Bills at once, which was a bit difficult at times. Perhaps that is an answer to those who say that we have not got enough to do in the Wales Office. I will not take that point any further in case there are further announcements this afternoon. It might amuse the Committee to know that the Lincolnshire Echo arrived in my office yesterday afternoon addressed to the Arab Republic of Egypt at Gwydyr house. I do not know if that is an indication of any changes in the Wales Office. 
 This is a substantial and important Bill for Wales. About 50 of the Bill's clauses apply wholly or partly to Wales. The Bill will continue the joint programme that the Government are pursuing with their colleagues in the Welsh Assembly further to raise health and social care standards in Wales. For Wales, the main effects of the Bill are the inspection, monitoring and enforcement of standards of health and social care providers. At earlier sittings, my right hon. and hon. Friends outlined proposals for the Commission for Healthcare, Audit and Inspection, the new body that will assess performance and enforce standards across a range of health care providers in England and Wales. 
 In addition, the Bill provides for the Welsh Assembly to undertake reviews and to investigate health care provision across a series of NHS bodies in Wales. CHAI will have a wide national remit. I take the point that was made by my hon. Friend the Member for Cardiff, Central (Mr. Jones)—by ''national'' the Bill is referring to England and Wales. However, the Assembly needs the opportunity and ability to monitor and to focus closely on addressing the health priorities that it set for the people of Wales. 
 The Healthcare Inspection Unit for Wales will undertake the reviews and inspections. It will adopt techniques that have been used successfully to review the social services in Wales and will provide a robust case for the improvement of clinical governance tailored to particular Welsh needs. 
 The Bill establishes the Commission for Social Care Inspection in England, and it places the responsibility for conducting such inspections in Wales on the Welsh Assembly. Consequently, it provides the same powers to the Assembly as are provided to the Secretary of State in England. Another significant change is that the Assembly will be given similar powers to those of the Secretary of State to prescribe a range of foods that are made available under the welfare food scheme. Those powers will allow the Assembly to broaden the nutritional basis of the scheme with particular regard to Welsh matters. 
 The Bill also recognises several other differences in the application and operation of the health service in Wales, which it would not be prudent of me to discuss at length at this stage. However, so that people may understand where I come from, and where the Government come from, I should say that I do not subscribe to tweaking every piece of legislation that comes through this place so that each has a ''made in Wales'' stamp on it. However, I do subscribe to a ''better for Wales'' stamp, whereby a piece of legislation can be improved by doing things slightly differently, as is proposed in this part of the Bill. 
 The amendments tabled in the name of my hon. Friend the Member for Ealing, North (Mr. Pound) take away the Assembly's discretion in preparing and publishing statements, standards and consultation documents. Under those amendments, it would be an absolute requirement for the Assembly to prepare and publish statements, standards and consultation documents. 
 The principle of the devolution settlement was the ability of the Assembly to conduct its business in an unrestricted way within the confines of the Government of Wales Act 1998, which was Parliament's intention when it handed over those powers and responsibilities to the Assembly. To impose an absolute requirement to prepare and publish statements, standards and consultation documents will run contrary to the fundamental principle that this place guaranteed when it passed that Act. It is for the Assembly to determine what action it should take on the provision of the health service in Wales, which is its remit through the process of secondary legislation that the Act conferred on the Assembly. 
 In setting standards, the Assembly consults those persons whom it considers appropriate and takes account of the standards set by bodies in England and Wales; for example, it refers to guidance provided by the National Institute for Clinical Excellence, the royal colleges and so forth. Moreover, amended powers conferred on the Assembly under the National Health Service Act 1977, to give direction to NHS trusts, special health authorities and local health boards, do not place an obligation on the Assembly, but rather permit it to issue such directions as it sees fit. 
 The hon. Member for Epsom and Ewell (Chris Grayling) made some important points in his useful contribution, as he did when he served on the Standing Committee on the Health (Wales) Bill. He researches well, but—this may surprise him—I disagree with several points that he made this morning. He was concerned about the question of standards, mainly the difference in standards that might apply in Wales and in England. 
 Standards set in Wales will be as high as those in England. They will be determined by the Assembly, but are likely to include the national clinical standards, the national service frameworks, the NICE guidelines and so on. Moreover, targets and other standards developed and issued by the Assembly will be taken into account in assessments. National standards, such 
 as the national service frameworks, underpin many of the standards determined by the Assembly. A clinical standards board for Wales will be set up to act as a mechanism to co-ordinate and monitor Welsh clinical standards.

Chris Grayling: Will the Under-Secretary confirm that, under the Bill, the Assembly has the right to ignore NICE?

Don Touhig: The Assembly will listen to points made by NICE. It was made clear last year, in discussion of the NHS Reform and Health Care Professions Bill, that NICE applies across England and Wales.

Chris Grayling: If the Welsh Assembly has the right to establish its own standards, does it have the legal right to decide that it will no longer listen to NICE? I accept that it might not choose to do so.

Don Touhig: That is not my understanding. We made it clear in discussions on the NHS Reform and Health Care Professions Bill last year that NICE applies across England and Wales.

Jon Owen Jones: Will the Under-Secretary give way?

Don Touhig: Will my hon. Friend permit me to make this one point? I will give way in a moment.
 Our problem in this discussion is the use of the word ''standards''. In my context, those are clinical standards, whereby a doctor treating a patient in England will have the same standards as a doctor treating a patient in Wales. We are confused by talk of ''standards'' when sometimes we mean ''targets''. Those are political with a big ''P'', in that the Government or the Assembly will set a target—an objective for delivery of the health service in Wales—and with a small ''p'', in that some NHS trusts will have a particular objective, target or mission statement which they want to see realised. That point must be clarified. 
 We use the word ''standards'' when all sorts of other things, such as targets, clinical standards and so on, are meant. There is a difference. The standards I refer to are those of delivery and the quality of health care. Targets are different—they are set by politicians, systems, Government Departments and agencies and others in order to achieve objectives.

Jon Owen Jones: Before the publication of the Bill, was consideration given in the Welsh Assembly and in the Government to a form of wording which involved the co-ordination of standards so that, as far as possible, common standards could be met? If not, could it now be considered during the Bill's progress in this House and in another place?

Don Touhig: Yes, of course there were discussions on the issue of standards at ministerial and official levels between the Department of Health and the Assembly. We shall try to ensure that the national standards that I mentioned are broadly similar across England and Wales in respect of CHAI. Those discussions are ongoing, and we shall, as I have said, seek to ensure that the standards in Wales are as high as those in England. That will involve much co-operation and collaboration between HIUW, CHAI and the various Departments.
 The hon. Member for Epsom and Ewell was also concerned about duplication. In previous sittings he has made several points about where he considers there may be waste, in that CHAI and HIUW would be in competition and that inspections would be duplicated. There will be no such duplication. CHAI's role in Wales is important, but it is restricted to undertaking—I apologise to my hon. Friend the Member for Cardiff, Central—national reviews in England and Wales of the particular health care provided by the English and Welsh NHS trusts, and so on. 
 The review of cross-border issues and special health authorities will be carried out by CHAI. Under section 41 of the Government of Wales Act, the Assembly, through HIUW, may enter into arrangements with CHAI, whereby CHAI may undertake investigations into serious service failures or malpractice on behalf of the health inspectorate in Wales and, if appropriate, accredit HIUW's inspection methodology. 
 The health care inspectorate in Wales will undertake reviews and investigations of Welsh NHS bodies using the joint review of the social service model that involves the participation of the Audit Commission. We have used that successfully in Wales. It will also assess the management arrangements that are in place to deliver NHS services, and the quality of NHS services across all the agencies and service providers. It might be helpful if I wrote to colleagues at the end of the sitting to give them a breakdown of how we see CHAI operating and how we see the health inspectorate unit in Wales operating, and to explain how their objectives are quite different.

Chris Grayling: The Under-Secretary has described the defining line between the two organisations. However, the point that I am seeking to make is that two organisations with two secretariats and so forth will inevitably create additional costs. Why is it necessary to have two organisations? Why will one inspectorate—CHAI—not be able to do the job properly for the people of England and Wales?

Peter Atkinson: Order. We are already straying away from the territory of clause 42 into that of clause 66. We will come to those matters later.

Don Touhig: I take the point, Mr. Atkinson. I will reserve some of my comments until we reach that part of the debate.
 The hon. Member for Epsom and Ewell mentioned some of the problems that we have had with delivering the health service in Wales. There are differences in the rates of treatment, particularly for orthopaedics in Wales. That is being addressed through further funding and reforms. To make a partisan point, I must say to the hon. Gentleman that 18 years of under-investment in the health service has left its mark in Wales. Certainly, we have serious difficulties in delivering health care in Wales. 
 Demographically, 17 per cent. of the population in Wales is aged over 65, compared with 15 per cent. in England. There are also regional differences within Wales. Only 14 per cent. of the population are over 65 in the constituency of my hon. Friend the Member for Cardiff, Central (Mr. Jones), compared with 25 per 
 cent. in Conwy in north Wales. We are seeking to address those differences with this legislation. 
 I am sure that we will have further debates on standards and so on when we move to clause 66, so I shall conclude at this point. As I said, I am not clear who moved these amendments, although they were tabled by my hon. Friend the Member for Ealing, North. I am told that, in a vote last week, he answered in Welsh. Some people say that Welsh is the language of heaven, but it is certainly not the language of this place. If my hon. Friend has the interests of Wales at heart, I invite him to withdraw the amendment so that we can make some progress.

Peter Atkinson: Order. The amendment was moved by the hon. Member for Epsom and Ewell, although he did not appear to be in favour of it.

Chris Grayling: You will therefore not be surprised to hear, Mr. Atkinson, that I beg to ask leave to withdraw the amendments.
 Amendment, by leave, withdrawn. 
 Clause 42 ordered to stand part of the Bill.

Clause 66 - Reviews and investigations relating to Wales

Chris Grayling: I beg to move amendment No. 533, in
clause 66, page 24 line 41, after 'conducting', insert 
 ', where appropriate in conjunction with the CHAI,'.

Peter Atkinson: With this it will be convenient to discuss the following:
 Amendment No. 588, in 
clause 66, page 25, line 17, at end insert— 
 '(f) the impact of its decisions upon the provision of healthcare in English border areas.'.
 Amendment No. 589, in 
clause 66, page 25, line 19, at end insert 
 ', or in the case of NHS Trusts which provide services to both English and Welsh patients, to statements published under sections 41 and 42.'.
 Amendment No. 590, in 
clause 66, page 25, line 23, leave out paragraph (b).
 Amendment No. 591, in 
clause 66, page 25, line 25, at end insert— 
 '(3A) For the purposes of subsection (1) the Assembly may request CHAI to provide it with a report on the provision of healthcare by an English NHS body to a Welsh NHS body.'.
 Amendment No. 534, in 
clause 67, page 25 line 29, leave out 'Secretary of State' and insert 'CHAI'.
 Amendment No. 592, in 
clause 67, page 25, line 29, leave out 'conducting' and insert 'receiving'.
 Amendment No. 593, in 
clause 68, page 26, line 9, leave out 'or for'.

Chris Grayling: These amendments are designed to tidy up some of the issues that we see arising from the provisions in the Bill. We do not wish to depart from the view that we have expressed on this side that it is absurd to have two inspection systems. Despite the
 Under-Secretary's reassuring words, I am not persuaded. It will be a waste of public money. It is entirely logical to have a single inspection system and I regret the fact that, given the Government's majority, this part of the Bill is likely to be approved.
 The amendments are designed to tidy up the structures that the Bill would put in place. They are also designed to remove part of the anomaly that gives Welsh inspectors powers in England, without providing for a reciprocal arrangement. The Assembly cannot—and must not—have the power to amble over the border and inspect an English hospital at will. That would impose a huge additional managerial burden on that hospital. We all know that a review of any kind—whether a hospital review by CHAI, an Ofsted review or the inspection of a local government organisation—takes up a huge amount of the management's time. 
 I recall a local authority chief executive saying that the inspection that she had just been through had taken up about 90 per cent. of her time for three months. Therefore, the arrival of an inspectorate to assess the performance of a hospital will inevitably take the hospital's chief executive away from his or her job to a significant degree and for a significant time. 
 The amendments are designed to ensure that that does not happen twice and that the Welsh inspectorate does not have clear authority to walk across the border and inspect an English hospital. They are also designed to ensure that the Welsh inspectorate does not hold powers over English NHS institutions that their English counterparts do not hold in Wales. I am sure that you agree, Mr. Atkinson, that it would be nonsense if the Welsh inspectorate were profoundly concerned about the service being provided at a hospital over the border in England and was able to inspect that hospital in detail and report to the Secretary of State. That would be particularly true if CHAI did not have a similar ability to represent effectively the interests of patients in English border areas by carrying out inspections across the border and by making recommendations about the quality of health care in Wales for English patients. 
 Such reciprocity does not appear to be in the Bill. Amendment No. 533, therefore, adds a duty to co-operate, where appropriate, with CHAI, and is a tone-setter for the amendments that follow. 
 Amendment No. 588 relates to page 25, line 17, at the end of the list of the various issues that the Assembly must take into account in exercising its functions under subsection (1). Essentially, subsection (2) outlines those matters that should be taken into account when the Assembly sets out the areas that it wants to review and sets the parameters for the Welsh inspectorate. Most of those are sensible in the context of any inspectorate, for example: 
''the quality and effectiveness of the health care''
and
''the availability of, and access to, the health care''.
 However, there is no duty in the Bill to understand the impact on the provision of health care in England of the decisions that are being taken. I shall give an example of how that might work. Hospital reconfiguration is a popular topic at present. Around the country, debates are taking place in the NHS and in local communities about the balance between acute hospitals and community hospitals, the future of individual community hospitals and the location of hospital services. 
 Let us suppose that there is one hospital 10 miles from the border with England and another 40 miles from the border. There is increased pressure, for example, to meet the requirements of the European 48-hour directive, and the trusts responsible for managing the hospitals may decide that the only way to continue to provide the full range of services at the two hospitals is to bring them together in a new hospital on a new site halfway between the two; or, indeed, on one of the existing sites. They may even decide that the hospital further away from the border was close enough to Wales to make provision for patients from some Welsh areas and, therefore, they would move services currently close to the English border further away from that border. That is perfectly conceivable. 
 Of course, that decision would not take into account the interests of English patients on the other side of the border who are used to using their local hospital. Under the terms of the Bill, Welsh NHS authorities have absolutely no duty of care to the patients they serve who live in England.

Jon Owen Jones: As the Bill is currently worded, a foundation hospital on the English side of the border would have no duty of care to its Welsh patients, nor any obligation to take into account their interests.

Chris Grayling: We debated that issue earlier, and the Government have gone some way to addressing it in their subsequent amendments. When the final amended Bill is produced at the end of the Committee, the hon. Gentleman and I will examine it carefully to see whether the Government have gone far enough in ensuring that that duty of care exists across borders.
 The purpose of amendment No. 588 is to place a duty on the NHS in Wales to be mindful of the fact that people in England use its services too. As such, I hope that the amendment will be considered non-controversial and that the Under-Secretary will accept it. It will not affect the quality of patient care in Wales; it simply requires the NHS authorities in Wales to remember that not all their patients are Welsh. 
 Amendment No. 590 relates to the carrying out of reviews and investigations. Clause 66(3)(b) gives the Assembly the power to conduct investigations into the provision of health care for a Welsh NHS body otherwise than by an NHS foundation trust. The key words are ''for a Welsh NHS body.'' Health care for a Welsh NHS body may well be provided across the border in England; that is one piece of our jigsaw puzzle of anxiety. We are concerned by the fact that Welsh authorities can carry out investigations across the border, while that situation does not exist in 
 reverse. The purpose of the amendment is to seek the Under-Secretary's views on the issue, and to urge him and his colleagues to consider how we can ensure that true reciprocity exists on both sides of the border—it is not apparent at the moment. 
 Amendment No. 591 proposes that the Assembly could request CHAI to provide it with a report on the provision of health care by an English NHS body to a Welsh NHS body. It is very much our hope that the Government and the Assembly will be willing to move in that direction. Rather than the Welsh having the ability to send their inspection teams over the border—a raiding party into English hospitals—they can phone CHAI and say ''We are not happy with the quality of care that Welsh patients are receiving at English hospital x. Please look at it for us.'' CHAI can then do the fieldwork and report to the Welsh Assembly as well as to the Secretary of State. The Assembly can use that report when holding dialogue with the English NHS to try to resolve the matter. 
 The Under-Secretary will see that one or two of our other amendments are designed to try to reinforce the point that it is not right to have two inspection teams floating around. Of course, it is right and proper that the Welsh NHS should be able to examine problems its patients encounter with English NHS trusts, but it is also right and proper that English NHS trusts and CHAI should have the same rights in reverse. That issue is not adequately dealt with in the Bill. 
 However, if there are to be two inspection teams, field work in hospitals in either England or Wales should be done by the local inspection team, which can then report back to the appropriate authority in the other country. 
 Amendments No. 534 and No. 592 deal with clause 67(1), which states that 
''The Assembly must report to the Secretary of State where, after conducting a review or investigation under section 66, it is of the view that—''
 and goes on to talk about the various failings in English NHS bodies. Amendment No. 534 would give back to CHAI the responsibility for reporting. CHAI is the organisation in England that has responsibility for highlighting to the Secretary of State English NHS trusts' performance shortcomings. We think that the report-back mechanism should fall to CHAI, which would compile a report for the Secretary of State. We do not want multiple reports about the performance of a hospital to land on the Secretary of State's desk. 
 For example, if an English hospital close to the Welsh border was underperforming and the Welsh Assembly was not happy with that hospital, it could ask CHAI to carry out an investigation. CHAI could then investigate and provide feedback. The Assembly would then wrap together a report that says, ''This is not working. These failings are having an adverse effect on the people of Wales'' and then detail those failings. The report would be packaged and passed back to CHAI, which would then provide the Secretary of State with a complete report on the hospital's performance. Surely that is the right way to do things, rather than to have two parallel reports; one from CHAI about the impact of the hospital's 
 underperformance on English patients and the other from the Welsh Assembly to the Secretary of State about the underperformance in respect of Welsh patients. Amendment No. 534 effectively would create a consistent channel for reporting an English NHS trust's performance back to the Secretary of State. 
 Amendment No. 592, arguably, is the most important. It would simply change the word ''conducting'' to ''receiving'' and would remove the Welsh Assembly's right to conduct investigations in England. The amendment would place on the Assembly a clear duty not to conduct any review itself by removing its ability to do so. Amendment No. 592, which would make CHAI the field work operator in carrying out the review, would be strengthened because clause 67 would simply refer to ''receiving'' a report. Again, the same principle applies. The Assembly should be able to commission CHAI to carry out the field work, but it should not be able to carry out that field work itself. 
 Amendment No. 593 concerns right of entry. Clause 68(1)(b)(i) would give a person who has been authorised by the Assembly the right to enter and inspect, at any reasonable time, any other premises used, or which are proposed to be used, for any purpose connected with 
''the provision of health care by or for a Welsh NHS body''.
 The problem with the words ''or for'' is that they will give the Welsh inspectors the right to access any facility on the English side of the border whenever they want. That seems to be wrong, because there is no corresponding right in the Bill for an English body. Neither CHAI—nor, indeed, the Secretary of State—has the right to demand access to a Welsh hospital in order to inspect the premises. There will be an inspection flow one way but not the other. 
 If Ministers are saying that it is right and appropriate that the parallel inspection systems have proper rights to review the services provided to their patients, regardless of where those services come from, surely that should be a two-way process. The point of the amendment—to delete the words ''or for''—would remove the right of a person authorised by the Assembly to access such a body in England. I am happy for the Under-Secretary to take away the amendment and use his drafting resources to rewrite it in a way that works better for him. 
 However, the principle seems unshakeable. Why can the Welsh Assembly access an NHS building in England, while CHAI—on behalf the English taxpayer and patients—cannot have the same access to a hospital in Wales in which services are provided to English patients? 
 This is a long set of amendments, but I hope that the Under-Secretary will be able to respond positively to some of them. I hope that he will accept that this is a real issue that must be addressed before the Bill reaches the statute books.

Jon Owen Jones: I have considerable sympathy with the arguments that the hon. Member for Epsom and Ewell has made in support of his amendments.
 I feel isolated. I do not wish to be too modest but, as the only Welsh Back-Bencher on the Committee, I do not think that on my own I can adequately represent Welsh interests on so many Welsh clauses. Until they read the Bill, the majority of Welsh MPs were under the impression that there was to be a joint inspectorate, not separate inspections. That has also been my impression since the production of the second Wanless report. Hon. Members may recall that the report's major conclusion was that funding for the national health service would be increased out of general taxation. There would, therefore, be one funding system, unlike the variety of funding systems in most European countries. 
 The report recognised that relying on one funding system reduced the accountability to different paymasters that existed within European systems. It was suggested that to make up for that structural lack of accountability, it would be necessary to introduce a rigorous, independent system of audit and inspection. I was under the impression that that rigorous, independent system of audit and inspection would be common to every part of the United Kingdom. I was rather surprised that that is not what is in the Bill. 
 At some point, the Department of Health and the Wales Office have been convinced by an argument to set up different inspections. So far, little effort has been made to convince anyone else that different inspections are a good idea, and there has been little debate about the merits of that idea. 
 The Committee has limited time, and few members with direct experience of the Welsh system, to examine how these issues would affect Wales. I hope that there will be much more discussion of the idea in the House of Lords. However, if there are to be different inspections, the arguments for reciprocity have been well made. I hope that my hon. Friend the Under-Secretary will consider carefully, if not the exact wording of the proposed amendments, at least the arguments behind them.

Gary Streeter: Two issues arise from this group of amendments and our debate. The first is whether there should be a separate inspectorate for Welsh NHS bodies. The hon. Member for Cardiff, Central has just spoken to that, and has expressed his surprise. The second issue is whether the Welsh Assembly, and the inspection system that it sets up and relies upon, should have access to English health care providers to Welsh NHS bodies. On that second point, I am unclear as to whether that is the Government's intention.
 It may be that, while locked in this room over the past three weeks, I momentarily lost concentration; an astonishing thought, but I may have fleetingly overlooked a Minister explaining precisely how the Bill is intended to operate in relation to inspections of cross-border bodies. However, I do not believe that to be true. 
 Clause 66 of the Bill makes it clear that the Welsh Assembly has the power to inspect English hospitals, 
 such as those in Liverpool or Chester, that provide health care to Welsh patients. Welsh patients are presumably part and parcel of the Welsh NHS body and general practice. Members must forgive me, but I am not entirely sure whether there are primary care trusts in Wales. If there are not, there will be equivalent organisations that could be described as Welsh NHS bodies for the purposes of clause 66(3)(b), clause 66(4) and clause 68(1)(b)(i), to which my hon. Friend the Member for Epsom and Ewell also referred. 
 Therefore, it seems that the Bill is drafted, whether intentionally or not, to give the Welsh Assembly the power to send inspectors into English hospitals. Such an inspection might occur as a result of a complaint made by a Welsh patient to a Welsh Assembly Member, who then would raise it in Cardiff, where other Members became excited and decided to send in the inspectors. 
 If I may say so, I was extremely impressed with the Under-Secretary's first outing in this Committee. He is obviously a Minister who seeks to give clarity. Therefore, I ask him to give the Committee maximum clarity on this issue. Was it the Government's intention to have a right to enter and inspect English hospitals? If that is the intention, I strongly agree with my hon. Friend the Member for Epsom and Ewell that that is a terrible waste of resources. It would also complicate and confuse English hospitals. 
 From constituency experience, we all know that when Ofsted decides to inspect a school, it is a nightmare for a month in advance as the school prepares. The inspection causes a very stressful week or two, and it takes the school the rest of the term to recover. The same applies to hospital inspections, regardless of whether hospitals gear up only for those weeks during which they know that certain departments will be inspected. 
 Inspections place a lot of focus on hospitals and cause much stress and distraction. It would horrify me if, for example, CHAI inspected a hospital in Liverpool in April and an inspectorate from the Welsh Assembly did the same thing three months later. Therefore, the points made by my hon. Friend the Member for Epsom and Ewell about the need for inspection in Wales to draw on existing inspection by CHAI were very well made. I hope that the Under-Secretary will be able to give the Committee clarity and focus on those points. If he cannot, the Bill must be amended. 
 I want to make another point about the list of paragraphs in clause 66(2). There are dangers, as every lawyer knows, in setting out a specific list of the functions, powers and focus to which a body is to have regard. I was interested to read in clause 66(2)(d) that the Welsh Assembly should have particular regard to 
''the need to safeguard and promote the rights and welfare of children''.
 Who could disagree with that? 
 The Under-Secretary mentioned that there is an unusually high level of retired people in Wales; 17 per cent., I think he said, as opposed to 15 per cent. in England. Therefore, why on earth have the rights and 
 welfare of children—which, of course, we all support—been singled out for attention in clause 66, while the rights and welfare of elderly and retired people have not? 
 Although the rights and welfare of elderly people flow through the entire subsection, when specifics are expressly mentioned, it is in the nature of we human beings to use them as a particular focus, resulting in other elements being left out and not receiving the same priority or attention. I would have thought that it rather important that if the Bill were to contain lists, they should refer not only to children, but to elderly and retired people. 
 I hope that the Under-Secretary—he has indicated that he is a reasonable man who listens and seeks clarity—can answer those questions. If he cannot, perhaps he will seek advice on the provisions and return to the Committee with greater clarity.

Paul Burstow: I support these amendments, which raise important issues about the way in which the Assembly will discharge its functions under the Bill. Reasoned points have been made by the hon. Member for Cardiff, Central about how that might better be arranged and how the resources of the new Commission for Healthcare Audit and Inspection could be used on some form of agency basis by the Assembly to enable it to discharge its responsibilities. I am sure that the Bill provides for such an agency arrangement. However, the Minister should give us some assurances that that possibility was explored during the discussions that led to the framing of the Bill, and that that arrangement is intended for the future operation of inspection in Wales. That would overcome our concern about the possibility of English NHS bodies being inspected by both HIUW and the Commission for Healthcare Audit and Inspection.
 The point about reciprocity is entirely fair, and I hope that the Minister, when responding to this group of amendments, can give us some assurance on that. It is important that in establishing the new architecture for inspection and regulation of health care we do not inadvertently create the possibility of further inspections, rather than reduce the number of inspections enjoyed by English NHS bodies. Clearly, a simple mechanism could be used to allow the commission to act on behalf of the Assembly in discharging its functions. That would tidy up the provisions in a way that would meet all the concerns raised so far in the debate.

Don Touhig: Clauses 66 and the clauses that follow give the Assembly powers to undertake reviews and investigations into the provision of health care by Welsh NHS bodies. They complete the review and investigation jigsaw by placing on the Assembly the duties and powers in respect of providing services to patients who are resident in Wales that are exercised by CHAI in respect of patients who are resident in England. By placing those responsibilities and powers on the Assembly, we are providing an important support for the Assembly's drive to improve the health and well-being of people in Wales by ensuring that the health priorities they set are specific to Wales and are addressed and monitored locally.
 I will take each of the amendments moved by the hon. Member for Epsom and Ewell in turn. The Government do not believe that amendment No. 533 is necessary. The Assembly and CHAI are under a duty to co-operate where appropriate under clause 132 for the effective and efficient discharge of their inspection functions. That could include co-ordination of reviews of health care, so that where it was considered appropriate, CHAI could review health care provided by an English NHS body for a Welsh NHS body. Furthermore, section 41 of the Government of Wales Act 1998, to which I referred in the previous debate, would allow CHAI and the Assembly to enter into arrangements whereby CHAI could exercise the inspection functions for the Assembly. That explains and overcomes some of the concerns that colleagues have about duplication, and one inspection being carried out by CHAI one week and another by HIUW the next.

Gary Streeter: Does the Bill give inspectors charged by the Welsh Assembly permission to enter English hospitals to carry out inspections?

Don Touhig: Yes, that would be possible if a hospital trust had been commissioned by a provider in Wales to carry out health care or treatments for Welsh patients.
 There is confusion about the roles of CHAI and HIUW compared with community health councils in Wales and patient forums in England. As hon. Members know, it has been made clear in previous legislation, most recently the Health (Wales) Act 2003, that a patient concerned about treatment from a provider, including a health service trust in England, can go to a community health council. In that Act, as the hon. Member for Epsom and Ewell will remember, we strengthened the power of those bodies and gave them advocacy roles on behalf of patients to conduct such investigations. A| reciprocal arrangement exists in England whereby patient forums can conduct the same sort of inquiries and inspections if there is a complaint from an English person who has been treated in a Welsh hospital about the standard or quality of care. However, we are not discussing that as far as CHAI and HIUW are concerned.

Chris Grayling: I am always surprised that the Minister manages to keep a straight face when he talks about community health councils, since he voted to scrap them in England but keep them in Wales. He just gave a clear answer to my hon. Friend the Member for South-West Devon (Mr. Streeter). Can he confirm that an English inspector will not have a statutory right to enter a Welsh hospital, yet a Welsh inspector will have a statutory right to enter an English hospital?

Don Touhig: CHAI would have the ability to inspect a Welsh trust if the patient care was commissioned by a body in England for patients in Wales.

Chris Grayling: Where does it say that in the Bill?

Don Touhig: I cannot answer that without further reading. However, the hon. Gentleman should accept that there are circumstances in which CHAI would inspect a Welsh health body if care had been
 commissioned by an English health body. I will clarify exactly where that provision is in the Bill. English inspectors will have such a right under clause 53(5), I believe. Colleagues may want to digest that point and return to it.
 The Government do not believe that amendment No. 534 is necessary because the Assembly should report to the Secretary of State any failings in the running of or provision of health care by an English NHS body where that has occurred. It is for the Secretary of State to consider what action should be taken in respect of English health care. Under clause 54, CHAI has a similar duty to report failings relating to the provision of English health care to the Secretary of State. The Secretary of State has responsibility for the provision of health services in England under section 2 of the National Health Service Act 1977 and has the power to issue direction to English NHS bodies.

Paul Burstow: I apologise if, in a moment of distraction, I misheard or did not hear the Under-Secretary state specifically how he envisages clause 53(5) applying to Welsh bodies. For the future construction and interpretation of the law in this respect, can he confirm that that clause is to be interpreted as including Welsh NHS bodies?

Don Touhig: Yes, I can confirm that.

Chris Grayling: As the Under-Secretary knows, lawyers can be extremely meticulous in their interpretation of detail. Might it therefore be prudent to insert on Report a reference that simply says: ''which may include Welsh NHS bodies'' or something similar?

Don Touhig: The hon. Gentleman makes a perfectly valid and proper point, and I have no doubt that my colleagues in the Department of Health will consider the report of this morning's proceedings and his comments. If it is felt appropriate to have further amendments, observations or clarity included on Report, I am sure that the opportunity will be taken to do that. However, I will make sure that his point is brought to the attention of my colleagues, particularly the Minister of State.
 I am not quite clear what is meant by ''decisions'' in amendment No. 588. The Assembly will not have any control over English NHS bodies nor will it be able to award any form of star rating in respect of such bodies. Instead, under clause 67 the Assembly will be under a duty to report to the Secretary of State if it considers that there are significant failings in the provision of health care or the running of an English NHS body or any other body or person providing health care for an English NHS body. It will be entirely for the Secretary of State to determine what action should be taken in respect of English NHS bodies. 
 The Government do not support amendment No. 589. Even if the Welsh Assembly wishes to review health care provided for Welsh NHS bodies by English NHS bodies, it will not issue any form of rating to such bodies. It is for CHAI to assess whether an 
 English NHS body fulfils the standards set by the Secretary of State, and to award the performance ratings accordingly. In turn, it is for the Secretary of State to take any action he or she deems fit in respect of a failing NHS body, by virtue of the powers already vested in that office under health legislation.

Chris Grayling: Amendment No. 589 refers back to clauses 41 and 42, which establish the standards. Does the Under-Secretary accept that the purpose of the amendment is to ensure that the Welsh inspectorate, when assessing the performance of a Welsh NHS body, is duty-bound to be mindful that that body may also have to work to an English set of standards, because it is serving English patients, and that that may affect the way in which the body carries out its work?

Don Touhig: That was implicit in my remarks in the debate in which we discussed the question of how to ensure that standards in England and Wales are comparable. It seems to be an obvious point, which would have to be taken into account in the circumstances that the hon. Gentleman describes. The Assembly will be required to advise the Secretary of State when, after conducting a review or investigation, it is of the view that there are significant failings in the running of an English NHS body, or the provision of care by such a body or by another body or person for an NHS trust.
 Amendments Nos. 595, 591 and 592 are not necessary. By virtue of section 1 of the National Health Service Act 1977 where functions were transferred from the Secretary of State to the Welsh Assembly under the National Assembly for Wales (Transfer of Functions) Order 1999, the Assembly has the duty to continue the promotion in Wales of a comprehensive health service, designed to secure improvement in the physical and mental health of the people of Wales. Under commissioning arrangements, NHS bodies in Wales will commission health care from bodies across the border in England. Accordingly, the Assembly will need to ensure that such health care is properly provided to Welsh residents, given its duty to provide a comprehensive health service in Wales. 
 Amendment No. 591 is not necessary, as the Welsh Assembly is required under clause 132 to co-operate with CHAI, where appropriate, for the efficient and effective discharge of their respective inspection functions. As such, both inspectorates will need to ensure that their reviews are properly co-ordinated—a point rightly made by the hon. Member for South-West Devon.

Gary Streeter: Does the Under-Secretary accept that clause 132 is really concerned with the robustness and effectiveness of the inspection from the inspector's point of view? The clause does not take into account the hospital's point of view or the inconvenience, cost and waste of possible duplicated inspections. Perhaps that needs to be tidied up?

Don Touhig: I thought that I had stated clearly that there must be co-ordination and that there should be no duplication. That would not be a sensible use of resources. If we are to drive up standards, we must
 have proper assessment and inspection of the services provided. Nowhere is that more important than in the health service. Were the Assembly to wish to review the health care provided by an English or a Welsh NHS body, it would need to ensure that that did not impede CHAI's timetable for reviews in any way.
 Amendment No. 593 causes me more concern. Its drafting is not clear. It would take away from the Assembly the power to enter the premises of English NHS bodies. The actual effect of the drafting of the amendment would mean that that the Assembly could not enter the premises of any person or body providing health care for Welsh NHS bodies. That would extend to health care providers situated in Wales, not just English NHS bodies. As far as the inspections are concerned, that would not be of any benefit.

Chris Grayling: I remind the Under-Secretary that I said that he might want to redraft the proposal, given that he has rather more substantial access to drafting resources than Opposition Members have. None the less, the point about the right of Welsh inspectors to access English premises at a moment of their choosing remains important.

Don Touhig: I take note of the hon. Gentleman's point.

Gary Streeter: Is the Under-Secretary right on that point? Clause 68(1)(a) talks about the right of the Assembly to:
''enter and inspect any—
(a) premises owned or controlled by a Welsh NHS body;''
 and goes on to include: 
''(b) any other premises used''.
 Therefore, although taking out ''or for '' in paragraph (b) might have some impact, it is overridden by the express provision in clause 68(1)(a) that the Assembly can enter any Welsh NHS body anyway.

Don Touhig: I have looked into the matter. Far be it from me to challenge the parliamentary draftsmen, but that was the advice that I received about the consequence of the amendment.
 The Assembly will wish to review and investigate health care provided by Welsh NHS bodies. That could be care provided by English NHS bodies or special health authorities or, indeed, care provided by other bodies or individuals in Wales. In all circumstances, the Assembly will need powers of entry into relevant premises whether they belong to Welsh or English NHS bodies or health care providers. 
 Several hon. Members made points during the debate, and I have answered most of the points made during the debate as far as I have been able.

Jon Owen Jones: The Under-Secretary has answered many of the points relating to the amendments, but he has not advanced any argument for the benefit of having a separate inspection regime. Underlying the arguments for the amendments is an attempt to make the best of a bad job and the deficiencies of having two inspectorate regimes. I do not know what we should read into that, but so far the Under-Secretary has not argued for the perceived benefit of having separate inspection regimes.

Don Touhig: I was not going to leave my hon. Friend the Member for Cardiff Central out of this debate by any means. He used to do the job that I now do—in fact, he had a greater degree of responsibility because he was formerly the health Minister for Wales. I know what a tremendous job he did: woe betide the chairman of any NHS trust who had not met the targets that he had set, because he would phone on a Monday morning to ask why. I will address the point that he makes.
 In the early discussions that took place between my officials, officials from the Department of Health and the Assembly, and at ministerial level, we examined the possibility of CHAI carrying out all the inspectorate functions across England and Wales. As my hon. Friend pointed out in his contribution, that was what he believed would happen until the Bill was published. However, we had extensive discussions with colleagues and became convinced that there was merit in having a separate inspection unit in Wales to carry out the sort of inspection that I mentioned earlier. As I told the Committee, I will provide Members with a breakdown of how we see the separate functions of CHAI and HIUW applying and the benefits that we believe they will bring. 
 My hon. Friend knows me well enough to know that I do not subscribe to making changes in legislation simply for the sake of having a ''Made in Wales'' stamp on it. However, when I think we can improve the delivery of any service by tweaking it, and if that benefits the people of Wales, we should do it because we can do so through the Government of Wales Act, through which many of these responsibilities and functions are devolved. I will write to hon. Members to set out why we regard the measure as important and set out clearly how the two operations, CHAI and HIUW, will provide a valuable service that will monitor and inspect our health service. 
 The hon. Member for South-West Devon spoke about clarity and about the clarification of inspections. I have covered that point. Legislation has already been passed to provide for community health councils in Wales and patient forums in England to act as representatives and advocates for those who feel that they have not been properly treated by the health service. Their concerns will be investigated. The concerns of a Welsh patient who has been treated in England will be investigated. The same arrangements apply to patient forums in England in respect of English patients. The hon. Gentleman also asked about children, and I shall write to him when I have received greater clarity on that matter. 
 The hon. Member for Sutton and Cheam (Mr. Burstow) also asked about the functions of CHAI and HIUW. I give him the same response as I gave my hon. Friend the Member for Cardiff, Central, and as soon as he sees my letter he will understand why we have gone down that road: it is the best way of delivering the inspection of the health service in Wales. I urge the hon. Member for Epsom and Ewell to withdraw his amendments.

Chris Grayling: I am happy to withdraw the amendments—on two or three conditions that I hope the Under-Secretary will meet. He said that amendment No. 589 was not needed, although its purpose is to ensure that the inspection regime in Wales has a duty to be mindful that some of the people whom they inspect must deal with two different sets of standards. I accept his point that the National Assembly for Wales may wish to be extremely consistent with the standards that have been set down by the Department of Health; however, it may not—who knows? Politics is a funny business, and we are leaving control over national standards in Wales in the hands of the Assembly.
 I therefore ask the Under-Secretary whether he would be willing, with his draftsmen, to reconsider the clause in order to ensure that they are happy that it contains such a duty and that the inspectorate will not be judging practitioners against standards that apply only to some of their patients. We must ensure that practitioners are not adversely judged because they operate to standards that are different from those in England. That is the first assurance that I seek from the Under-Secretary. 
 The second assurance that I seek relates to amendment No. 588. The Under-Secretary's quibble was with the word ''decisions''. He might dispute the drafting of the amendment. Perhaps it should contain a duty of availability and access to health care in English border areas, as is the case in Welsh border areas. My concern is that the inspectorate will be asked to carry out inspections and to make recommendations about the strategy and direction of Welsh NHS trusts without any reference to its task of catering for patients in England. Therefore I ask the Under-Secretary to consider whether inserting a stipulation to be mindful of availability and access to health care in English border areas should be included as one of the duties in this part of the Bill. 
 If the Under-Secretary gives me those assurances I shall withdraw the amendments. Although it may not happen, it is clear that the Bill gives the two inspectorates in England and Wales the right to inspect the same institution in the same year, but at different times. I trust and hope that that will not happen. I accept that clause 132 provides for a duty of co-operation between the two inspectorates, but I cannot see anything to prevent dual inspection. The Under-Secretary must understand the burden that two inspections would place on hospital management: it would be daft. We must bear in mind that we are framing legislation. We are not talking about ideals or what we expect to happen—we are talking about the law of the land. The law of the land will permit two inspectorates to inspect the same hospital within a short time. That is wrong, and Ministers would do well to consider that carefully before the Bill is placed on the statute book. 
 I am not certain, Mr. Atkinson, whether you intend to allow a clause stand part debate; I suspect that you may judge that such a debate has taken place. Therefore, in anticipation of such a ruling, let me say that we firmly do not believe that a single patient will 
 benefit as a result of having two separate inspectorates—it will not enhance patient care one iota. What will HIUW do for patients in Wales that CHAI will not? If HIUW has a hidden mystery ingredient that will make a huge difference to the people of Wales, can we please have it in England? Otherwise, we will end up with a scenario similar to the absurd CHC situation, whereby one set of Ministers told the House that it was time for CHCs to pass on, only for them to be replaced a few weeks later by another set of Ministers who said that CHCs are the way of the future. Indeed, as I pointed out, the Under-Secretary voted for both of those options. 
 To be frank, the Under-Secretary did not truly answer the questions asked by the hon. Member for Cardiff, Central. What will the creation of a second inspectorate bring to the people of Wales that CHAI serving both England and Wales could not? What is the mystery ingredient? What is it about a second inspectorate that will improve patient care in such a way that a single inspectorate cannot? Does the Under-Secretary agree that if we do not have a second inspectorate, money that might pay for a few extra hip replacements or the like for patients in Wales will undoubtedly be saved? Are we not doing those patients a disservice, rather than a service, in creating a second inspectorate? 
 I hope that the Under-Secretary will respond briefly to my points, after which I will be happy to withdraw the amendments. However, I give him notice that we will support neither clause 66 nor clause 67—they are wrong.

Jon Owen Jones: I assume that we will not have a clause stand part debate, but in answer to the questions that I asked the Under-Secretary, he has agreed to write to us to explain the advantages of having two inspectorates. Therefore as it currently stands, I have no idea what the advantages are that outweigh the obvious disadvantages of having two inspectorates. I harbour a dark suspicion that some will perceive one advantage to be the avoidance of a degree of accountability, which is the exact opposite of the point of establishing a strong inspectorate in the first place. However, I continue to see no advantage to a separate inspectorate for patients in Wales; indeed, the reason for that separate inspectorate has not been explained to me.
 Wales must have as independent an inspection system as England. It is immensely difficult to ensure an efficient, effective health service, given the existence of this monopolistic provision and the fact that the taxpayer constitutes the sole funding stream. In Wales, the population base and the number of hospitals to be inspected are much smaller than in England, and I am fearful about the inspectorate achieving sufficient autonomy and independence from its political masters. I have concerns about the proposal in the Bill, and I do not support a separate inspectorate for Wales.

Don Touhig: This has been a useful debate. I do not take the view that Bills cannot be improved by debates in Standing Committees. Standing Committees exist to scrutinise Government legislation properly and, where appropriate, to revise and amend that legislation.
 I will take account of the points made by the hon. Member for Epsom and Ewell about amendments No. 589 and No. 588. I will read today's proceedings in Hansard, and if certain points require a further response, I will take those into account on Report. In the meantime, if I think that further clarification is required, I will write to hon. Members. The hon. Gentleman referred to the dual inspection roles of CHAI and HIUW. We can demonstrate the importance and value of the methods outlined in our proposals. I explained the benefits earlier, but as promised I will write to colleagues before Report to ensure that they have the fullest information in order to understand why we have chosen that route. 
 Perhaps my hon. Friend the Member for Cardiff, Central and I might have a word later. We are both former Whips as well as good comrades and good friends, so I might be able to remind him where we might have had an opportunity to discuss these matters elsewhere. However, he makes an important point; we must make it clear why we are going down our chosen route. He also has concerns about demonstrating the independence of HIUW. That is an important issue, and my right hon. Friend the Minister of State, Department of Health, has clarified the independence of CHAI in England. 
 It is important that the Committee has the fullest understanding of how we propose to demonstrate the independence HIUW in the same way as the Bill demonstrates the independence of CHAI in England. I have sent two letters about this issue to Ministers in the Welsh Assembly, copies of which I will release to hon. Members within the next day or so. They will then see in detail why we believe that HIUW will be sufficiently independent of politicians to carry out its proper functions. 
 I recognise that the hon. Member for Epsom and Ewell is perhaps prepared to withdraw his amendments. I will ensure that the Committee has all the information to which I have referred.

Chris Grayling: I am grateful to the Under-Secretary for the thoughtful way in which he has responded to my specific questions. None the less, we shall take a rather more robust view of the big picture issues. I beg leave to withdraw the amendment.
 Amendment, by leave, withdrawn. 
 Amendments made: No. 306, in 
clause 66, page 25, line 4, leave out 
 'otherwise than by an NHS foundation trust'.
 No. 445, in 
clause 66, page 25, line 20, leave out 
 'subject to this Part, conduct' 
 and insert 'carry out'.
 No. 307, in 
clause 66, page 25, line 23, leave out 
 'other than an NHS foundation trust'.—[Mr. Hutton.]
 Question put, That the clause, as amended, stand part of the Bill:—
The Committee divided: Ayes 14, Noes, 6.

Question accordingly agreed to. 
 Clause 66, as amended, ordered to stand part of the Bill.

Clause 67 - Reporting to Secretary of State

Question proposed, That the clause stand part of the Bill.

George Young: Clause 67 is consequential on clause 66, but it seems to go a little wider, particularly in subsection (1)(c). Can the Minister take us through why he needs that subsection? As I understand clause 66, which we have just discussed, the Welsh Assembly has a mandate where Welsh patients are treated in English hospitals. I have no difficulty with that. Under clause 66(3) that mandate is restricted to situations where health care is being provided for a Welsh NHS body, albeit by an English trust.
 However, under clause 67(1)(c) it seems that the Assembly has much wider powers, because if it finds significant failings in an English body that is providing services not to Welsh patients but to an English primary care trust, it now has the right to report that to the Secretary of State. It is not immediately clear why clause 67(1)(c) goes so much wider than clause 66(3)(b). Can the Minister explain what appears to be a significant widening of the mandate of the Welsh Assembly in respect of English NHS bodies?

Don Touhig: As I understand the intention behind subsection (1)(c), it will apply where a person from Wales has been treated at a hospital in England and there has been some form of deficiency in the health provision. There would be the opportunity to report that matter to the Secretary of State. There is a similar provision in relation to CHAI in reporting matters to the Secretary of State arising from English inspections. It seems perfectly proper to follow on from there.

George Young: In those circumstances, although the care would be provided by an English hospital, would it not be a Welsh NHS body that was paying for it?

Don Touhig: Yes, it would be care commissioned by a Welsh NHS body.

George Young: In that case I do not understand why subsection (1)(c) refers to
''providing health care for an English NHS body''.
 The Welsh Assembly has an interest where health care is being provided for a Welsh NHS body by an English trust, but paragraph (c) seems to go slightly wider.

Don Touhig: This is a very interesting debate.

Paul Burstow: I will try to help the Minister. Will he consider the point that in this clause the Secretary of State is stipulated as the person to whom the Welsh inspectorate should report? Surely, given that CHAI is to discharge these responsibilities in England, it ought to be CHAI to which the Welsh inspectorate reports, so that CHAI can then discharge its responsibilities for NHS bodies in England providing care to English patients. That would seem to be consistent within this clause, and I hope that the Minister will be able to explain that. Is there a specific responsibility on CHAI to report to the Welsh Assembly if it finds similar problems in NHS hospitals in Wales?

Peter Atkinson: We have addressed that point in amendment 534, which we dealt with earlier.

Don Touhig: I did respond to that point.

Evan Harris: There has been some confusion about subsection (1)(c), which works with subsection (1)(b) to cover private or voluntary hospitals that provide health care. By definition, paragraph (b) applies only to an English NHS body. The point made by the right hon. Member for North-West Hampshire (Sir George Young) might apply equally to paragraphs (b) and (c). How would the Assembly know about problems if it did not have the free-standing ability to inspect those areas providing Welsh-commissioned services? If the Assembly were providing those services, presumably it would already have the power to take action without reporting to a third party.

Don Touhig: Clause 67 states:
(1) ''The Assembly must report to the Secretary of State where, after conducting a review or investigation under section 66, it is of the view that
(a) there are significant failings in relation to the provision of health care by or for an English NHS body or cross-border SHA; or
(b) there are significant failings in the running of an English NHS body or cross-border SHA;
(c) there are significant failings in the running of any body, or the practice of any individual, providing health care for an English NHS body or cross-border SHA.''
 There could be a series of arrangements, for example, the care provider for a Welsh body could be sub-delegated by an English body to be provided by an independent person or body. We want to ensure that if any deficiencies are discovered, there is a mechanism for bringing them to the attention of the appropriate person so that action can be taken; that person would be the Secretary of State in England. It would not be appropriate for the Assembly to take action, but if any of its inspections were to discover any failing, clause 67 provides that the matter should go to the Secretary of State for him to take note and, where appropriate, take action.

Chris Grayling: My right hon. Friend the Member for North-West Hampshire makes an interesting
 point. Does the Under-Secretary accept that theoretically under the terms of this part of the Bill the inspectorate in Wales, as the body responsible for services that cross borders, could investigate the Coventry, Warwickshire, Herefordshire and Worcestershire strategic health authority and mount a further inspection or investigation into a hospital in Coventry, for example? Clause 67 creates an almost open-ended inspection flow outwards from Wales.

Don Touhig: I thought that our earlier debate had covered the ability of CHAI and HIUW to inspect across borders when a provider in England commissions health provision into Wales and vice versa. The clause is clear on that issue. We want to ensure that any failure, discrepancy or difficulty is brought to the attention of the person with the appropriate power or responsibility to take action to correct such shortcomings. Health commissioners in Wales already come from English bodies. That is covered by the patient advocacy legislation.
 In relation to the inspectorates, we should ensure that if there are any problems or difficulties, they are brought to the attention of the Secretary of State. This clause seeks to do that.

George Young: I am sorry to labour the point, but I should like to take the Under-Secretary through my dilemma. Clause 67 is consequential on clause 66 since clause 67(1) states:
''The Assembly must report to the Secretary of State where, after conducting a review or investigation under section 66,''
 Clause 67 follows clause 66. In clause 66(3)(b), the Assembly's powers of inspection are restricted to circumstances in which health care is provided for a Welsh NHS body. It may be provided by an English hospital, but it is for a Welsh NHS body. That is the Assembly's mandate. However, under clause 67(1)(c), the Assembly's mandate does not just cover circumstances in which health care is provided for a Welsh NHS body, but also applies where services are provided by an English NHS hospital for an English NHS body. I do not understand why it says ''Welsh NHS body'' in clause 66(3)(b) but ''English NHS body'' in clause 67(1)(c).

Evan Harris: Will the right hon. Gentleman give way?

George Young: If the hon. Gentleman can shed some light on this, he will succeed where the Under-Secretary has so far failed.

Evan Harris: I think that I can. Clause 66 provides for the investigation of a person, independent hospital or English NHS hospital that provides services for Welsh and English patients. Let us say that the Welsh inspectors find a dodgy lab when carrying out such an inspection. Since that lab provides services for English patients, it would be reasonable for the Assembly responsibly to report the lab to the English authorities and to inform them that it may affect English patients. That would be appropriate risk management. A serendipitous finding during an inspection of a hospital providing services for the people of Wales that may impact on English patients will be reported to the English authorities.

George Young: I am grateful to the putative Minister for his response. In those circumstances, one does not need the words ''English NHS body'' because they also provide for a Welsh NHS body. I agree that if inspectors came across something that also affected English patients, they should respond. However, that is already covered under clause 66(3)(b). In the circumstances mentioned, health care is being provided for a Welsh NHS body. Clause 67(1)(c) goes far wider than that. Although the hon. Gentleman has made a valiant attempt, I still do not understand why it says ''English'' in clause 67(1)(c) and ''Welsh'' in clause 66(3)(b).

Evan Harris: The Under-Secretary will probably correct me if I am wrong, but there may be a small independent unit or person who is providing services only for the Welsh because that person's only contract is over the border with a Welsh commissioner. It would be inappropriate for the inspectors to draw the English authorities' attention to that because it does not involve either an ''English NHS body'', as in clause 67(1)(b), or the provision of services for an English NHS body. The clause is competent, but whether it is overly fussy is a separate question.

George Young: During this interesting exchange, the Under-Secretary has had some in-flight refuelling. It may be that he can now shed light on the issues that we have both raised and bring this debate to a satisfactory conclusion.

Don Touhig: I reiterate my earlier point that under this clause:
''The Assembly must report to the Secretary of State where, after conducting a review or investigation under section 66, it is of the view that—''
 and that is followed by paragraphs (a), (b) and (c). We would all agree that if in any way it could be demonstrated that there was a failing in any health service provider, that should be investigated. This clause allows that to be done. Health care for a Welsh NHS body could encompass care provided by an independent body in England, such as an independent clinic. That could cover a host of organisations. 
 In view of the right hon. Gentleman's concerns, I will examine the matter further. Clarification is necessary so that everyone understands the objectives. I shall write to Members, if that is acceptable, to make the Government's intentions clear, but those intentions are along the lines that I have explained. However, I want to ensure that colleagues are given the details with full authority. If hon. Members are happy with that, I shall do that today. 
 Question put and agreed to. 
 Clause 67 ordered to stand part of the Bill.

Clause 68 - Right of Entry

Question proposed, That the clause stand part of the Bill.

Simon Burns: I am grateful to have the opportunity to discuss briefly clause 68,
 which deals with the right of entry under the reviews for investigations. Clauses 69 to 71 inevitably flow from clause 68, which is the main clause. I am particularly pleased because the content of those clauses is also dealt with in clauses 62 to 65, but relates to a different body. Indeed, the argument will be repeated in clauses 95 and 98 for a third body. We were unable to debate how those clauses refer to CHAI under clauses 62 to 65 because of the guillotine at the end of the sitting on Tuesday.
 I want the Under-Secretary to clarify several issues that flow from the powers that clause 68 proposes to grant. It is logical that if a piece of legislation allowed a review and investigation system, those who carry those out must have sufficient powers and abilities to satisfactorily conclude them. However, it seems that the powers of the right of entry under clause 68 are extremely wide ranging with few checks and balances, which means that the system could be abused. I do not suggest that there will be abuse. However, if one prepares legislation and confers powers of such a sweeping nature, one has a duty to consider that it is possible that an individual might abuse those powers. There should be sufficient safeguards against that. 
 Under clause 68, if it considers it necessary or expedient, the Welsh Assembly can authorise a person to: 
''at any reasonable time, enter and inspect any—
(a) premises owned or controlled by a Welsh NHS body;
(b) any other premises used, or proposed to be used, for any purpose connected with—
 (i) the provision of health care by or for a Welsh NHS body; or
 (ii) the discharge of any of the functions of a Welsh NHS body.''
 That is an all-embracing power. Will the Under-Secretary tell us his intentions so far as that is concerned? For example, what is meant by 
''considers it necessary or expedient''?
 Attempts are made in subsequent clauses to give greater information about that. I will not stray too far down that line, because I might be considered out of order. However, will the Under-Secretary expand on that in layman's language? 
 What is meant by ''at any reasonable time''? What might be a reasonable time to one person may not be a reasonable time to another. For example, in sensitive investigations, the police regard a reasonable time to be 5 o' clock or 6 o' clock in the morning. Will the Bill give that sort of power to authorised individuals? An explanation of ''any reasonable time'' would be helpful. 
 In clause 68(1)(b), the power to enter and inspect ''any other premises used'' seems straightforward. However, what is meant by: 
''or proposed to be used''?
 There should not be an opportunity for nit-picking arguments to arise over what would seem to a non-lawyer to be a nebulous definition. What are the checks against abuse? Are they in another part of the Bill? Is the Assembly the right body to have sole authorisation of a person to carry out rights of entry? 
 Would it not be an improvement, and a greater protection against abuse, if a court order were required following an Assembly decision to hold an investigation or review and it was necessary for a person to have right of entry to premises? In certain circumstances, such as in more serious and sensitive reviews and investigations, the requirement of a court order would provide an additional safeguard to ensure that there was no abuse.

Don Touhig: Clauses 68 to 71 provide the Welsh Assembly with rights equivalent to those conferred on CHAI, and clauses 62 to 65 provide for the right to enter Welsh NHS body premises to inspect documents and records, to interview people and to require documents, information and explanations. If an inspectorate is to do its work properly, it must be able to have access to premises and appropriate records. The powers conferred under those clauses will allow the Welsh Assembly to undertake reviews and investigations into the provision of health care by Welsh NHS bodies. As I have said, the clauses complete the review and investigation of the Assembly's powers and ensure that the Assembly can carry out the duties we have placed upon it regarding the delivery of the health service.
 The hon. Member for West Chelmsford (Mr. Burns) mentioned right of entry and queried the phrasing in clause 68(1): 
''A person authorised to do so by the Assembly may, if the Assembly considers it necessary or expedient for the purposes of this Chapter, at any reasonable time enter and inspect . . . ''.
 A ''reasonable time'' would not necessarily be in the middle of the night or the early hours of the morning. The hon. Gentleman mentioned how the police would operate. Clearly, the police would deal with matters of a suspected criminal nature. We consider that a ''reasonable time'' would be an appropriate time—such as working hours—to allow the Assembly to access records so that it could carry out a proper and thorough investigation. That would allow the Assembly to ensure that all complaints or failures of delivery were properly assessed and that the appropriate action is taken. 
 We covered some of these points in our debates on the Health (Wales) Act 2003, where we gave community health councils in Wales rights of access to obtain documents and information, and gave patient forums in England the same rights regarding complaints about the running of the health service there. It is entirely consistent with the proper discharge of the duties of a body charged with responsibility for inspection and assessment to have rights of entry and access to the necessary documents so that it can produce reports and conclusions. 
 Question put and agreed to. 
 Clause 68 ordered to stand part of the Bill.

Clause 69 - Right of entry: supplementary

Amendments made: No. 308, in 
clause 69, page 26, line 17, leave out 'and take copies of' and insert 
 ', take copies of and remove from the premises'.
 No. 446, in 
clause 69, page 26, line 23, at end insert 
 'and 
 (d) make any other examination into the state and management of the premises and treatment of persons receiving health care there.'.
 No. 309, in 
clause 69, page 26, line 34, after 'enter', insert 'and inspect'.—[Mr. Touhig.]
 Clause 69, as amended, ordered to stand part of the Bill. 
 Clauses 70, 71, 89 and 90 agreed to.

Clause 91 - Reviews and investigations

Don Touhig: I beg to move amendment No. 449, in
clause 91, page 35, line 38, at end insert— 
 '( ) The Assembly may by regulations require a local authority in Wales to pay a fee to the Assembly in respect of the exercise of the Assembly's function under this section in relation to the functions referred to in section 43(3)(a) and (b) of the Care Standards Act 2000 (adoption and fostering functions). 
 ( ) A fee under this section shall be of such amount, and shall be payable at such a time, as may be specified in the regulations. 
 ( ) A fee payable by virtue of this section may, without prejudice to any method of recovery, be recovered summarily as a civil debt.'.
 The clause provides the Assembly with the power to make regulations specifying an annual fee payable to it by local authorities for its reviews and investigations into local authority adoption and fostering services. It is important that the Assembly can raise revenue through fees in those circumstances to ensure that there is a level playing field between adoption and fostering services provided by local authorities and those provided independently. Independent services are liable to pay fees under the Care Standards Act 2000. 
 Amendment agreed to. 
 Clause 91, as amended, ordered to stand part of the Bill.

Clause 92 - Studies as to economy, efficiency etc.

Question proposed, That the clause stand part of the Bill.

Jon Owen Jones: Clause 92(1), like most of the provisions, is enabling in that it uses the word ''may''. It states that the Assembly ''may promote'', not that it should or must do so. However, clause 92(3) states:
''The Assembly must publish or otherwise make available—
(a) any recommendations made by it under subsection (1); and
(b) a report on the result of any studies under this section.''
 I am not against the Bill's placing a duty on the Assembly to publish those reports; I simply wonder why clause 92(3) is so singular. It instructs the Assembly to act, whereas every other clause, by using words such as ''may'', gives the Assembly the option of acting. Why should clause 92(3) place a duty on the Assembly when none of the other clauses do?

Don Touhig: Clause 92 replicates for the Assembly the powers that sections 33 and 34 of the Audit Commission Act 1998 confer on the Audit Commission for local authority social services. It also mirrors the provision sought for England under clause 78. That means that the Assembly will be able to carry out studies that will allow it to make recommendations for improving economy, efficiency and effectiveness in the provision of local authority social services.
 Those provisions do not detract in any way from the Audit Commission's powers. It will retain powers that will enable it to carry out studies of local authority social services. The Social Services Inspectorate for Wales and the Audit Commission will continue to co-operate in carrying out joint reviews of local authority social services in Wales and in bringing together professional services, inspection and audit expertise. Where the primary focus is on social services, it is intended that the Assembly will conduct the study, calling on the assistance and expertise of the Audit Commission as necessary. Where the primary focus is on general local authority services or on services other than social services, the Audit Commission will take the lead in the study, calling on the assistance of the Assembly as required. 
 To respond to the point made by my hon. Friend the Member for Cardiff, Central, once the Assembly decides to undertake a study, it is under a duty to publish the results. The word ''must'' appears because that is a requirement.

Jon Owen Jones: I am satisfied with the Minister's explanation. Clause 90 states:
''Where the Assembly conducts a review under this section it must publish such report as it considers appropriate.''
 Clause 91 uses almost the same words, and such wording appears frequently in the Bill, but it does not make a great deal of sense to me to say that a body ''must'' conduct a review and ''must'' publish, and then add the words ''as appropriate'' at the end. The Bill may as well say ''may'' publish, because if the body can decide what is appropriate, what is the point of using the word ''must''?

Don Touhig: I hope that my hon. Friend will accept that when the Assembly undertakes a study, it has a duty to publish the results of that study as a report. That requirement exists now, and my hon. Friend is aware of the way that those studies are scrutinised by colleagues in the Assembly. The provision reinforces the fact that a duty is placed on the Assembly to publish a report when it undertakes a study.
 Question put and agreed to. 
 Clause 92 ordered to stand part of the Bill. 
 Clauses 93 to 95 ordered to stand part of the Bill.

Clause 96 - Right of entry: supplementary

Amendment made: No. 324, in 
clause 96, page 37, line 19, leave out 'and take copies of' and insert 
 ', take copies of and remove from the premises'.—[Mr. Touhig.]
 Clause 96, as amended, ordered to stand part of the Bill. 
 Clauses 97, 98 and 106 ordered to stand part of the Bill.

Clause 110 - Complaints about health care: Welsh bodies

Question proposed, That the clause stand part of the Bill.

Paul Burstow: I have concerns about how the powers provided under the clause enabling the Assembly to make regulations will work in practice. How does the clause address the issue of duplications that may occur in the system? That concern applies equally to the practice of dealing with complaints in NHS bodies in England and in Wales. In debating some of the recent clauses, we did not consider in any way, shape or form the provisions dealing with complaints in respect of English NHS bodies, but in respect of Wales I want to tease out from the Minister how the powers might be used and whether they would be allowed to be used in a certain way.
 I will use the example of a Welsh NHS acute trust that carries out a poor assessment, resulting in the early discharge of a patient to intermediate care provided by a primary care trust in Wales. That primary care trust then fails to pick up the fact that the patient has been prematurely discharged, and as a result it fails to take the necessary steps for a readmission to the acute trust. In those circumstances, is it reasonable to expect the patient, when complaining about the nature of the treatment that they have experienced, to navigate their way round the system and to decide whether it is the acute trust or the primary care trust—or indeed both bodies—to which they should make a complaint? They might find themselves having to deal with several different complaint processes about different aspects of one ongoing patient journey. 
 Do the powers in clause 110 provide for regulations to be made by the Welsh Assembly that would require NHS bodies to co-operate in dealing with patient complaints? That applies particularly in terms of sharing information between NHS bodies, or nominating one or other of the NHS bodies dealing with the complaint to act as the lead body for giving a comprehensive response to the complainant. Where issues of negligence come into play, NHS bodies, whether primary care trusts, acute trusts or other bodies, are suddenly more reluctant to share information. They may have an interest in ensuring that they do not end up with the responsibility of dealing with the consequences of a successful negligence claim. 
 I was anxious to take the opportunity to take up those issues with the Minister under clause 110. It seems to me that they are not entirely addressed within the regulation-making powers. It would be most helpful if the Minister could give me some reassurance on the matter.

Don Touhig: Section 20 of the National Health Service Reform and Health Care Professions Act 2002 places a statutory duty on health care providers and on
 local authorities to develop well-being strategies. That partly covers the point that the hon. Gentleman made about discharge—the problems of discharge have already been covered in previous legislation. The Health (Wales) Act also gave strengthened powers to community health councils. In England those powers were given to patient forums so that they could act as advocates for a person who had a complaint about his treatment.
 The provisions in the Bill will allow us to implement a robust complaints process that reflects the needs and concerns of Welsh patients, and we must ensure that they have confidence in the procedure. The clause gives the Assembly regulation-making powers covering the NHS complaints procedure, but replaces the present direction-making powers. That would ensure that we have a health care complaints system in Wales that could be tailored to the needs and concerns of Welsh patients. The handling of the second stage of the complaints procedure will be different in Wales. In England, it will be carried out by CHAI; in Wales, trained lay people appointed by the Assembly will carry it out. The provisions in the Bill allow for cross-border situations and links in social services to be dealt with. I hope that that helps the hon. Gentleman.

Paul Burstow: That is helpful. I appreciate that there are some differences between arrangements in England and Wales. I take from that that it would be possible for regulations to be made by the Assembly to allow for greater co-operation and to place a requirement on NHS bodies in Wales to co-operate when dealing with complaints, so that the patient does not have to go through numerous NHS bodies.

Don Touhig: Much of that is covered in the Health (Wales) Act, in which we strengthen the advocacy role of community health councils to ensure that a patient's voice can be heard and complaints in Wales are properly investigated.
 Question put and agreed to. 
 Clause 110 ordered to stand part of the Bill. 
 Clauses 112, 129, 130 and 131 ordered to stand part of the Bill.

Clause 132 - Co-operation between Assembly and CHAI

Amendment made: No. 331, in 
clause 132, page 56, line 40, leave out from '2000' to end of line 42. 
 NEW CLAUSES RELATING TO PART 2—[Mr. Touhig.]
 Question proposed, That the clause, as amended, stand part of the Bill.

Jon Owen Jones: I welcome the clause. We must ensure that there is co-operation between the Assembly and CHAI. However, will the Under-Secretary explain why the wording is so woolly? Clause 132(1) states that
''The Assembly and the CHAI must co-operate with each other where it seems to them appropriate to do so.''
 The words 
''where it seems to them appropriate to do so''
 are excessively woolly and allow either the Assembly or CHAI to avoid co-operation for any reason whatever. Although I cannot imagine why CHAI would want to avoid co-operation, the wording should be stronger. Would the words ''the Assembly and the CHAI must co-operate with each other where it is appropriate to do so'' not be better? I would like the Government to consider whether the provision can be tightened.

Evan Harris: I will add a few more comments to those already made about clause 132, because my hon. Friend the Member for Sutton and Cheam, the hon. Member for Cardiff, Central and others spoke about unnecessary duplication if there was not co-operation.
 I want the Under-Secretary to clarify another point in relation to clause 132(1). If the Assembly feels it appropriate that CHAI and the Assembly co-operate, but for whatever reason CHAI does not, does that mean that there need not be any co-operation? Does the wording 
''The Assembly and the CHAI must co-operate with each other where it seems to them appropriate to do so''
 apply to both of them, allowing one or the other to have a veto on the duty to co-operate, if it seems to one of them not to be ''appropriate to do so''? 
 Can the Under-Secretary, from his knowledge of other clauses, clarify whether, among the many direction-making powers that the Secretary of State has over the whimsically entitled independent inspectorate that is CHAI, it is possible to impose a direction on CHAI to co-operate for the furtherance of Government policy? Can that be done by means of other directions from the Secretary of State under the wide direction-making powers that he has been given in other clauses?

Don Touhig: Amendment No. 331 extends the duties of the Assembly and CHAI to co-operate with each other, where it seems to both of them to be appropriate for the efficient and effective discharge of any of the Assembly's functions under the Care Standards Act 2000. It is a small but important amendment, which seeks to extend the circumstances in which the Assembly and CHAI can agree to work together from private and voluntary health care to other services covered by that Act. That will increase the overall efficiency and effectiveness of the regulatory arrangements. I recall from Hansard that my hon. Friend the Member for Cardiff, Central made that point on 5 June 2003.
 It is important to put in place effective mechanisms to ensure that CHAI and the Assembly, through HIUW, co-operate fully in the best interests of monitoring and assessing the performance and quality of health care provision. Amendment No. 331 seeks to strengthen that, and I hope that colleagues will welcome and support it, because it is going in the right direction.

Gary Streeter: Coming down to specifics, I should like to consider the case of a hospital that feels that it is being over-investigated, with too many inspections being carried out by both bodies, perhaps in the course of the same financial year. If a hospital trust, whether foundation or otherwise, were to approach the Under-
 Secretary and say that the procedure was too expensive and time-consuming and that it seemed to be getting out of hand, would the Under-Secretary be prepared to intervene and ask CHAI and the Assembly to co-ordinate and co-operate more fully?

Don Touhig: That would not fall within my remit; it would be a matter for my colleagues, the Secretary of State for Health in England and the Minister for Health and Social Services in Wales.
 We talked earlier about seeking to avoid the unnecessary duplication of a body being inspected by both CHAI and the Assembly. They will have to work closely to ensure that that does not happen, but I do not believe that it will. Those two bodies will develop, and they will collaborate and co-operate together to set their standards and working practices. There is no way, therefore, in my view, that both would inspect one hospital trust one week after another. That would not make sense, and it would be wholly irresponsible and a waste of public funds.

Evan Harris: I am a little confused about the procedure, because I thought that we had just voted on amendment No. 331 and that we were debating clause stand part. The hon. Member for Cardiff, Central asked about clause 132(1), rather than clause 132(2)(d), which amendment No. 331 amends, in relation to the Care Standards Act. The Under-Secretary in his reply may have been reading from the section introducing the amendment that we have just voted on. I apologise if I have got that wrong.
 Certainly, however, the Under-Secretary did not address one of my questions, which was whether the Secretary of State had direction-making powers with regard to CHAI's co-operation with the Assembly, where there is disagreement between the two bodies on whether it is efficient to co-operate.

Jon Owen Jones: Further to that point, I was not raising questions about amendment No. 331, which I thought had already been agreed to, but about whether the clause stand part of the Bill.

Peter Atkinson: We are indeed on clause stand part.

Don Touhig: I accept that, Mr. Atkinson. I was seeking to explain why the amendment enhanced what we were seeking to do about co-operation through clause 132. I am not clear about the point that the hon. Member for Oxford West and Abingdon (Dr. Harris) made about the powers of Ministers to direct CHAI, but I will investigate it further and write to him and the Committee to clarify it.

Evan Harris: On the earlier point that I raised, the Assembly may want CHAI to do some of the inspection work in Wales, at least around the border, and would presumably offer some remuneration to CHAI for that work. I imagine that that is how it might work under contract. If CHAI does not like the price, it could say that it does not feel that it is appropriate for the efficient and effective discharge of its relevant function. Does this clause, therefore, provide CHAI with the ability to negotiate from a strong position of non-co-operation if it does not feel
 that it is getting the right amount of remuneration or consideration from the Assembly?

Don Touhig: I am not certain whether the hon. Gentleman was present when we debated the points about the ability of the Assembly to carry out investigations in Wales where it was appropriate. In those circumstances there would be discussions between the Assembly or HIUW, which would be responsible for the inspection, and CHAI about fees, and an agreement would be reached to the benefit of both sides. Ultimately, we seek to have the best possible quality of inspection and audit in order to drive up standards in the health service.
 Question put and agreed to. 
 Clause 132, as amended, ordered to stand part of the Bill.

New Clause 1 - Duty to have regard to

'(1) In exercising any of its functions the CSCI must have regard to such aspects of government policy as the Secretary of State may direct in writing. 
 (2) A direction given under this section may be varied or revoked by a further such direction.'.—[Mr. Lammy.]
 Brought up, read the First and Second time, and added to the Bill.

New Clause 2 - Arrangements with the Isle of Man

'(1) The CHAI may make arrangements with— 
 (a) the Government of the Isle of Man, 
 (b) the States of Jersey, or 
 (c) the States of Guernsey, 
 for the CHAI to advise and assist that authority with respect to the provision of health care by them or on their behalf. 
 (2) The terms and conditions of arrangements under this section may include provision with respect to the making of payments to the CHAI in respect of the cost to it of performing or providing any functions, services or facilities under the arrangements.'.—[Mr. Lammy.]
 Brought up, and read the First time.

David Lammy: I beg to move, That the clause be read a Second time.

Peter Atkinson: With this it will be convenient to take Government new clause 3.

David Lammy: The Governments of the Isle of Man, Jersey and Guernsey have specifically requested that these new clauses be included in the Bill. It is consistent and desirable that the ability to advise and assist should extend to Governments in the Isle of Man, Jersey and Guernsey, and these amendments make that provision.

Simon Burns: What happens with regard to Alderney and Sark?

David Lammy: I will seek advice on that and get back to the hon. Gentleman, if I may.
 These clauses are a response to requests by the Isle of Man, Jersey and Guernsey to allow a procedural 
 position to be prepared and approved in time for introduction. It is right that we should be able to help our colleagues across the water, should they so wish, and these provisions make that allowance. 
 Question put and agreed to. 
 Clause read a Second time, and added to the Bill.

New Clause 3 - Arrangements with the Isle of Man

'(1) The CSCI may make arrangements with— 
 (a) the Government of the Isle of Man, 
 (b) the States of Jersey, or 
 (c) the States of Guernsey, 
 for the CSCI to advise and assist that authority with respect to the provision of any services which are similar to English local authority social services. 
 (2) The terms and conditions of arrangements under this section may include provision with respect to the making of payments to the CSCI in respect of the cost to it of performing or providing any functions, services or facilities under the arrangements.'.—[Mr. Lammy.]
 Brought up, read the First and Second time, and added to the Bill.

New Clause 5 - Provision of material

'(1) The CHAI must, on request, provide the Comptroller and Auditor General with any material relevant to a review or investigation under sections 51 to 53 or a study under section 56. 
 (2) The CHAI must, on request, provide the regulator with— 
 (a) any material which is relevant to a review or investigation under sections 51 to 53 and relates to the provision of health care by or for an NHS foundation trust; 
 (b) any material which is relevant to a study under section 56 and relates to an NHS foundation trust.'.—[Mr. Lammy.]
 Brought up, read the First and Second time, and added to the Bill.

New Clause 6 - Boarding schools and colleges: reports

'In section 87 of the Children Act 1989 (c.41), after subsection (9) insert— 
 ''(9A) The Commission and the National Assembly for Wales must each publish such reports in relation to the exercise of its functions under this section as it considers appropriate. 
 (9B) The Commission and the National Assembly for Wales must each make copies of any report published by it under this section available for inspection at its offices by any person at any reasonable time. 
 (9C) Any person who requests a copy of a report published under this section is entitled to have one on payment of such reasonable fee (if any) as the Commission or the National Assembly for Wales (as the case may be) considers appropriate.''.'. 
 —[Mr. Lammy.]
 Brought up, read the First and Second time, and added to the Bill.

New Clause 12 - CHAI fees: Wales

'(1) The CHAI may from time to time make and publish provision— 
 (a) requiring a Welsh NHS body to pay a fee in respect of the exercise by the CHAI, in relation to that body, of such of its functions under this Chapter as may be prescribed; 
 (b) requiring a person of a prescribed description who provides health care for a Welsh NHS body to pay a fee in respect of the exercise by the CHAI, in relation to the health care so provided by that person, of such of its functions under this Chapter as may be prescribed. 
 (2) The CHAI may not under subsection (1)(b) require an English NHS body or crossborder SHA to pay a fee. 
 (3) The amount of a fee payable under provision under subsection (1) shall be such as may be specified in, or calculated or determined under, the provision. 
 (4) Provision under subsection (1) may include provision— 
 (a) for different fees to be paid in different cases, or classes of case; 
 (b) for different fees to be paid by persons of different descriptions; 
 (c) for the amount of a fee to be determined by the CHAI in accordance with specified factors; 
 (d) for the time by which a fee must be paid. 
 (5) Before making any provision under subsection (1) the CHAI must consult such persons as appear to it appropriate. 
 (6) The Assembly may by regulations make provision as to— 
 (a) the manner in which provision under subsection (1) is to be made and published; 
 (b) the matters to be taken into account by the CHAI before making the provision. 
 (7) The Assembly may by regulations make provision for an independent person or panel to review the amount charged under subsection (1) in any particular case and, if that person or panel thinks fit, to substitute a lesser amount for that amount. 
 (8) For the purpose of determining the fee payable by a person or body under subsection (1), the person or body must provide the CHAI with such information, in such form, as the CHAI may require. 
 (9) A fee payable by virtue of this section may, without prejudice to any other method of recovery, be recovered summarily as a civil debt.' 
 —[Mr. Lammy.]
 Brought up, read the First and Second time, and added to the Bill.

New Clause 13 - Duty to have regard to

'(1) In exercising any of its functions the CHAI must have regard to such aspects of government policy as the Secretary of State may direct. 
 (2) Subsection (1) does not apply in relation to any of the CHAI's functions under section 49(1), 50, 52 or 54. 
 (3) In exercising any of its functions under any of the sections referred to in subsection (2)— 
 (a) where the exercise relates to the provision of health care by or for an English NHS body or crossborder SHA, the CHAI must have regard to such aspects of government policy as the Secretary of State may direct; and 
 (b) where the exercise relates to the provision of health care by or for a Welsh NHS body, the CHAI must have regard to such aspects of the Assembly's policy as the Assembly may direct. 
 (4) In relation to any function conferred on the CHAI under subsection (1)(a) of section 57, regulations under that section may do either or both of the following— 
 (a) they may disapply subsection (1) of this section in relation to that function; 
 (b) they may require the CHAI, in exercising the function in relation to the provision of health care by or for a Welsh NHS body, to have regard to such aspects of the Assembly's policy as the Assembly may direct. 
 (5) A direction under this section— 
 (a) must be given in writing; 
 (b) may be varied or revoked by a further direction under this section.'.—[Mr. Lammy.]
 Brought up, and read the First time. 
 Motion made, and Question put, That the clause be read a Second time:—
The Committee divided: Ayes 14, Noes 9.

Question accordingly agreed to. 
 Clause read a Second time, and added to the Bill.

New Clause 14 - Criteria

'(1) The Secretary of State may, after consulting the CHAI, make regulations requiring the CHAI to devise and publish statements of criteria to be used in— 
 (a) the exercise of any of its functions under section 49(1), 50, 52 or 54 in relation to the provision of health care by or for an English NHS body or crossborder SHA; 
 (b) the exercise of any of its functions under section 53, 55, 56 or 57(1)(b); 
 (2) The Assembly may, after consulting the CHAI, make regulations requiring the CHAI to devise and publish statements of criteria to be used in the exercise of its functions under section 49(1), 50, 52 or 54 in relation to the provision of health care by or for a Welsh NHS body. 
 (3) In relation to any function conferred on the CHAI under subsection (1)(a) of section 57, regulations under that section may provide that any one or more of the following provisions of this section shall have effect as if it included a reference to the exercise of that function— 
 (a) subsection (1)(a); 
 (b) subsection (1)(b); 
 (c) subsection (2). 
 (4) Regulations under this section may require the CHAI— 
 (a) to obtain the consent of the Secretary of State before publishing a statement under subsection (1); 
 (b) to obtain the consent of the Assembly before publishing a statement under subsection (2).'.—[Mr. Lammy.]
 Brought up, read the First and Second time, and added to the Bill.

New Clause 15 - Failure in discharge of functions: CHAI

'(1) Where the Secretary of State considers that the CHAI is to a significant extent— 
 (a) failing to discharge any of its functions under this Act; or 
 (b) failing properly to discharge any of those functions; 
 he may give a direction to the CHAI. 
 (2) The Secretary of State must consult the Assembly before giving a direction under this section in respect of a failure which— 
 (a) relates to any function of the CHAI under section 49(1), 50, 52 or 54; and 
 (b) relates to the provision of health care by or for a Welsh NHS body. 
 (3) Regulations under section 57 may, in relation to any function conferred on the CHAI under subsection (1)(a) of that section, provide that— 
 (a) the Assembly, and not the Secretary of State, may give directions to CHAI under subsection (1); 
 (b) the Assembly, as well as the Secretary of State, may give directions to the CHAI under subsection (1). 
 (4) The CHAI must comply with any direction given to it under this section. 
 (5) A direction given under this section— 
 (a) must be given in writing; 
 (b) may be varied or revoked by a further direction under this section.'.—[Mr. Lammy.]
 Brought up, read the First and Second time, and added to the Bill. 
 Further consideration adjourned.—[Jim Fitzpatrick.] 
 Adjourned accordingly at twenty-four minutes past Eleven o'clock till this day at half-past Two o'clock.